Key outputs were more focused training, supervision, guideline development and implementation, and outcome monitoring.
There is an urgent need to create data processes and supervision guidelines that complement existing workflows and service delivery priorities.
The root causes of these data quality weaknesses lay in suboptimal field level data collection, consolidation and transfer processes, inconsistent training levels for health staff and a lack of clear monitoring and supervision guidelines.
All but one supervisor (96.8%) were trained prior to the intervention on how to use supervision guidelines, execute performance reviews, and monitor achievements.
Notwithstanding the existence of the detailed clinic supervision manual (48), there appears to be a disjuncture between the supervision guidelines in the manual and the clinic managers' diary reflections of an unsupportive management environment.
While some of the quality improvement measures that we have suggested may require significant investment and time to implement, others such as providing ongoing training, supportive supervision, guideline development and the development of triage systems in hospitals can be positive first steps.
The MoH developed a quality assurance program in 1994, and support supervision guidelines were published in 2000.
Revised health supervision guidelines in 1995 [ 10] and 2000 [ 11] limited screening to only two age groups, five-year-olds and sexually active adolescents.
The results of the study suggest that the intervention package, which included supportive supervision guidelines, district-level trainings, continuous supervision and support during a 12 month period, monitoring and evaluation of provider performance and funding for district CPH to carry out the supportive supervision missions (travel and communication costs), were implemented as planned.
In light of the lack of clear benefit associated with screening urinalysis relative to its associated costs and risks, the AAP in 2007 removed routine screening urinalysis for asymptomatic children and adolescents from its health supervision guidelines altogether [ 15].
